Professor Paul Little MBBS, BA, MD, DLSHTM, MRCP, FRCGP, FMedSci

Professor of Primary Care Research

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Professor Paul Little is Professor of Primary Care Research within Medicine at the University of Southampton.

Professor Little was the first GP to be awarded a Wellcome HSR training fellowship (for research on health promotion), and the first to be awarded an MRC Clinician Scientist Fellowship (for research on common self-limiting illness), and in addition current major areas of research are in enabling behaviour change both for health professionals and also in empowering patients.

Qualifications

BA Physiology, Oxford (1981)MBBS, London (1984)MRCP, London (1989)MD, London (1992)MRCGP, London (1992)DLSHTM, London (1995)MSc, LSHTM (1995)FRCGP, London (2000)FMedSci, London (2010)

Appointments held

Wellcome HSR Fellow, University of Southampton (1993-1997)

MRC Clinician Scientist, University of Southampton (1998-2003)

Current Post: Professor of Primary Care Research.

Aldermoor Health Centre, Southampton University commenced 1/2/2003

Research

Responsibilities

Publications

Teaching

Media

Contact

Research interests

Two main areas of interest: health promotion and the management of common self-limiting illnesses. These topics link evidence about effectiveness with the effect of management of patient beliefs and behaviour, better understanding the importance of the patient centred approach to the consultation.

Health promotion

Back PainATEAM trial

This was an MRC funded trial of the Alexander Technique (a technique to improve and modify poor postural and body ‘use’ habits) and exercise prescription by GPs for back pain (the ATEAM trial). It demonstrated significant benefits for pain and function in the longer term.

ASPEN trial

Following the ATEAM trial EME have now funded this study to investigate the mechanisms of Alexander Technique and the mechanism of recovery in back pain with both physiotherapy and the Alexander Technique.

ARC Fellowship (Lisa Roberts)

I am co-investigator and mentor for this project which aims to understand communication in physiotherapy consultations and will then develop and pilot and intervention to modify consultation behaviour.

Internet based behaviour support

A major focus of interest is in developing internet based behavioural support for a range of conditions:RECON (PGfAR programme to limit cognitive decline)CLASP (PGfAR programme to support cancer survivors)Obesity (the HTA funded POWeR trial)Hypertension (SMILE trial, funded by the National School for Primary Care Research)Infection transmission (The MRC PRIMIT trial) Irritable bowel syndrome (NIHR funded, lead by Hazel Everitt)Eczema (NIHR funded, lead by Miriam Santer)

The management of common infections

UTIS studyFollowing our work in trialling antibiotic prescribing strategies in several respiratory infections we completed a study to develop clinical scoring algorithm for urinary tract infections leading to a trial of different management approaches.

GRACEWe have just completed two major trials as part of a large European Union Network of Excellence project (GRACE) for Lower respiratory tract infection - which is the commonest acute condition managed in primary care.RCT of amoxicillin: this trial which is coming to a close has randomized 2061 individuals in 12 Networks across Europe and the results are likely to dominate the management of lower respiratory tract infection (LRTI) in primary care for some time.

GRACE INTROThe second GRACE trial developed from another EU project we share (CHAMP), developed and tailored web based communication training packages for health professionals in 6 EU countries. We randomized 246 practices across Europe and recruited more than 4000 patients in this trial - which assessed whether an internet based behavioural intervention to modify communication in the consultation can modify health professional antibiotic prescribing for LRTI.

DESCARTEThis was a large prognostic cohort study in acute sore throat (more than 13000 patients were recruited) funded by the MRC.

PRISMThis was an HTA funded study to develop and perform a randomized trial (which has recruited more than 1500 patients) of strategies for using rapid tests and clinical scores for sore throat.

PRIMITThe MRC have funded us to develop and trial an infection control website requiring complex intervention development.

Internet DrAn MRC studentship was used to develop web based self help advice using the MRC Framework for the development of complex interventions.

NIHR PRIME Programme grantThis supported several studies on the management of acute and recurrent infections:PIPS: steam, paracetamol and ibuprofen for acute respiratory infections.SNIFS: nasal irrigation and steam for recurrent sinusitis.TASTE: probiotics and xylitol for recurrent sore throat.3C’s study (Cough Complication Cohort): a large prospective cohort similar to DESCARTE but for LRTIInternet Dr trial (following the development referred to above).

ARTIC-PCThis is an HTA funded trial to asses the impact of antibiotics for chest infections in children.

Research project(s)

Infectious diseases are a major threat to human wellbeing and economic and social development. Influenza, a highly contagious virus, causes a common respiratory infection with local and systemic symptoms.

Many patients in primary care are being prescribed antibiotics to treat mild infections such as colds, earaches and sore throats. Many of these are viral rather than bacterial infections that get better on their own and which can be treated with self-care (such as rest, fluids and mild pain killers).

We are looking to investigate the usefulness of antibiotics in this age group, it follows a European wide trial that was very similar for adults. Children will be provided antibiotic or placebo and keep a symptom diary for up to 28 days. They can opt to provide a throat swab, a blood sample and have a chest x-ray.

Although effective medicinal treatment exists for asthma, many people continue to have distressing symptoms and impaired quality of life. People with asthma have expressed interest in non-drug asthma treatments, particularly in breathing exercises. Several recent studies have shown benefits from a short course of breathing exercises taught by a respiratory physiotherapist for people with asthma who remained symptomatic despite usual treatment. We believe that many NHS patients could potentially benefit from these exercises, but unfortunately, there is currently not enough access to suitable trained physiotherapists able to provide such a service. We propose to provide the same breathing training programme that we have previously shown to be effective when taught 'face-to-face' by a physiotherapist in the form of a DVD, or internet download. Patients will use this in their own home at times convenient to them, in addition to their standard treatment (e.g. with inhalers). We will find out whether this type of instruction is better than the 'usual care' that is currently provided, and whether it is as good as the 'face to face' physiotherapist instruction (which is more expensive and less convenient for patients).

The population is getting older (over 3 million people [5%] in the UK are >80 years) and the number of people living with multiple long-term conditions taking multiple drugs is increasing. High blood pressure is one of the most common conditions in older patients and up to half of this population receive two or more drugs to treat it. However, recent evidence suggests that large reductions in blood pressure, and too many drug prescriptions may be associated with an increase in serious falls and death in the elderly.

The DIPSS (Integrating Digital Interventions into Patient Self-Management Support) project has received funding of £2 million from the NIHR to examine patient digital self-management with healthcare professional support in primary care. Our aim is to develop digital behaviour change interventions for asthma and hypertension self-management, which will be examined in feasibility studies and full RCT (hypertension only). Issues surrounding the feasibility, acceptability, effectiveness and cost-effectiveness of digital intervention delivery will be explored with patients and healthcare professionals for each condition.

Divisional responsibilities

Member of Management team for Primary Care and Population Sciences Division.

National and International Responsibilities

Head of Southampton primary care group for National Primary Care HODs group and also for the National School for Primary Care Research.Director of NIHR Programme Grants for Applied Research (PGfAR) BoardMember of REF panel for Public Health, Health services and Primary care.Fellow of the Academy of Medical Sciences

7 Aug 2015Internet programme to encourage hand washing reduces spread of cold and flu viruses, continue reading here. 26 May 2015Professor Paul Little has been quoted in the Telegraph about a new study published in the British Journal of General Practice. Paul and his team of researchers video-taped the consultations of 320 patients who visited 25 doctors in Southampton and found that, in contradiction to previous research, ‘patients actually preferred a traditional style of doctor, who knew them personally, but who was relatively distant and professional.’

8 December 2014Paul Little was quoted in the Daily Mail about the University's earlier research on the best treatment for coughs, colds and sore throats.

8 November 2013New test for patients with sore throats cuts antibiotic use by nearly a third. Please click here for full news item.

30 July 2013Internet-based training could help in the fight against antibiotic resistance. Please click here for full news item.